Evaluation of a Novel Transfusion Algorithm Employing Point-of-care Coagulation Assays in Cardiac Surgery

2015 ◽  
Vol 122 (3) ◽  
pp. 560-570 ◽  
Author(s):  
Keyvan Karkouti ◽  
Stuart A. McCluskey ◽  
Jeannie Callum ◽  
John Freedman ◽  
Rita Selby ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Time Trends ◽  
Point Of Care ◽  
Interrupted Time Series ◽  
Blood Products ◽  
Interrupted Time Series Analysis ◽  
Point Of Care Testing ◽  
Coagulation Testing ◽  
Coagulation Tests ◽  
The Many

Abstract Background: Cardiac surgery requiring the use of cardiopulmonary bypass is frequently complicated by coagulopathic bleeding that, largely due to the shortcomings of conventional coagulation tests, is difficult to manage. This study evaluated a novel transfusion algorithm that uses point-of-care coagulation testing. Methods: Consecutive patients who underwent cardiac surgery with bypass at one hospital before (January 1, 2012 to January 6, 2013) and after (January 7, 2013 to December 13, 2013) institution of an algorithm that used the results of point-of-care testing (ROTEM®; Tem International GmBH, Munich, Germany; Plateletworks®; Helena Laboratories, Beaumont, TX) during bypass to guide management of coagulopathy were included. Pre- and postalgorithm outcomes were compared using interrupted time-series analysis to control for secular time trends and other confounders. Results: Pre- and postalgorithm groups included 1,311 and 1,170 patients, respectively. Transfusion rates for all blood products (except for cryoprecipitate, which did not change) were decreased after algorithm institution. After controlling for secular pre- and postalgorithm time trends and potential confounders, the posttransfusion odds ratios (95% CIs) for erythrocytes, platelets, and plasma were 0.50 (0.32 to 0.77), 0.22 (0.13 to 0.37), and 0.20 (0.12 to 0.34), respectively. There were no indications that the algorithm worsened any of the measured processes of care or outcomes. Conclusions: Institution of a transfusion algorithm based on point-of-care testing was associated with reduced transfusions. This suggests that the algorithm could improve the management of the many patients who develop coagulopathic bleeding after cardiac surgery. The generalizability of the findings needs to be confirmed.

Point-of-Care Coagulation Testing in Cardiac Surgery

2017 ◽  
Vol 43 (04) ◽  
pp. 386-396 ◽  
Author(s):  
Kenichi Tanaka ◽  
Daniel Bolliger
Keyword(s):  
Cardiac Surgery ◽  
Point Of Care ◽  
Postoperative Bleeding ◽  
Blood Platelet ◽  
Heparin Therapy ◽  
Bleeding Complications ◽  
Treatment Algorithms ◽  
Product Usage ◽  
Coagulation Testing ◽  
Coagulation Tests

AbstractBleeding complications after cardiac surgery are common and are associated with increased morbidity and mortality. Their etiology is multifactorial, and treatment decisions are time sensitive. Point-of-care (POC) testing has an advantage over standard laboratory tests for faster turn-around times, and timely decision on coagulation intervention(s). The most common POC coagulation testing is the activated clotting time (ACT), used to monitor heparin therapy while on cardiopulmonary bypass. Viscoelastic coagulation tests including thromboelastometry (ROTEM) and thromboelastography (TEG) have been recommended for the treatment of postoperative bleeding after cardiac surgery because the ROTEM/TEG-guided treatment algorithms reduced the use of blood products. Other POC tests are commercially available, but there is sparse evidence for their routine use in cardiac surgery. These devices include heparin management systems, POC prothrombin time and activated partial thromboplastin time, POC fibrinogen assay, and whole blood platelet function tests. There are multiple confounding elements and conditions associated with cardiac surgery, which can significantly alter test results. Anemia and thrombocytopenia are regularly associated with deviations in many POC devices. In summary, POC coagulation testing allows for rapid clinical decisions in hematological interventions, and, when used in conjunction with a proper transfusion algorithm, may reduce blood product usage, and potentially complications associated with blood transfusion.

scholarly journals Comparison of Standard Coagulation Testing with Thromboelastometry Tests in Cardiac Surgery

2019 ◽  
Vol 11 (4) ◽  
pp. 300-304 ◽  
Author(s):  
Elham Khalaf- Adeli ◽  
Mostafa Alavi ◽  
Alireza Alizadeh-Ghavidel ◽  
Ali Akbar Pourfathollah
Keyword(s):  
Cardiac Surgery ◽  
Reference Range ◽  
Point Of Care ◽  
Valve Surgery ◽  
Limited Data ◽  
Point Of Care Test ◽  
Transfusion Requirements ◽  
Coagulation Testing ◽  
Coagulation Tests ◽  
Before And After

Introduction: According to the several evidences, using thromboelastometry as a point of care test canbe effective in reduction in blood loss and transfusion requirements in cardiac surgeries. However,there are limited data regarding to the comparison of thromboelastometry and the standard coagulationtests. In this study, we compared thromboelastometry and standard coagulation tests (PT, PTT andfibrinogen level) in patients under combined coronary-valve surgery. Methods: Forty adult patients who were under on-pump combined coronary-valve surgery wereincluded in this study. Thromboelastometry tests Fibtem, Intem, Extem and Heptem), along withstandard coagulation tests (PT, PTT and fibrinogen assay) were simultaneously performed in two timepoints, before and after the pump (pre-CPB and post-CPB, respectively). Results: A total of 80 blood samples were analyzed. There were no significant correlation between PTtest and the CT-Extem parameter as well as PTT and CT-Intem parameter either in pre-CPB and post-CPB (P > 0.05). On the contrary, fibrinogen level had high correlation with A10-Fibtem and A10-Extemin pre-PCB (P < 0.05). 82% of PT and 84% of PTT measurements were outside the reference range,while abnormal CT in Extem and Intem was observed in 17.9%. Conclusion: For management of bleeding, adequate perioperative haemostatic monitoring isindispensable during cardiac surgery. Standard coagulation tests are time consuming and cannot beinterchangeably used with thromboelastomety and relying on their results to decide whether bloodtransfusion is necessary, leads to the inappropriate transfusion.

Use of Quantra point-of-care coagulation testing device for guiding transfusion in cardiac surgery

2018 ◽  
Vol 32 ◽  
pp. S56
Author(s):  
Wael Zghaibe ◽  
A.A. Klein ◽  
G. Blaudszun ◽  
K. Munting ◽  
M. Besser
Keyword(s):  
Cardiac Surgery ◽  
Point Of Care ◽  
Testing Device ◽  
Coagulation Testing

scholarly journals Management of Major Obstetric Haemorrhage using ROTEM Point-of-Care Haemostasis Analysers Can Reduce Blood Product usage Without Increasing Fibrinogen Replacement Therapy

2018 ◽  
Vol 11 (3) ◽  
pp. 1167-1176
Author(s):  
Beatrice O. Ondondo
Keyword(s):  
Blood Loss ◽  
Replacement Therapy ◽  
Blood Product ◽  
Point Of Care ◽  
Blood Products ◽  
Transfusion Therapy ◽  
Product Usage ◽  
Obstetric Haemorrhage ◽  
Coagulation Tests ◽  
Fibrinogen Replacement Therapy

Major obstetric haemorrhage (MOH) is a leading cause of maternal death and morbidity, with the majority of deaths occurring within four hours of delivery. Therefore, prompt identification of women at risk of MOH is crucial for the rapid assessment and management of blood loss to urgently restore haemodynamic stability. Furthermore, as the rate of blood loss during MOH can increase rapidly in the time when laboratory results are awaited, the management of MOH could benefit from point-of-care coagulation testing by the ROTEM analyser which has a quicker turnaround time compared to standard laboratory coagulation tests. A number of studies indicate that ROTEM-based management of MOH has resulted in a significant reduction in massive transfusions and decreased transfusion of concentrated red cells (CRC) and fresh frozen plasma (FFP) due to a reduction in total blood loss. Several reports which have linked MOH to the depletion of fibrinogen reserves indicate that the reduction in CRC and FFP transfusions is largely due to an increase in early fibrinogen replacement therapy which corrects hypofibrinogenemia. This short report discusses preliminary findings on the impact of ROTEM point-of-care haemostasis analyser on the transfusion of various blood products to obstetric women experiencing MOH at the Royal Gwent Hospital in South wales. The number of blood products transfused following decisions based on the ROTEM analyser measurements (ROTEM group) was compared to historical transfusion data before the ROTEM analyser became available (Pre-ROTEM group). Blood product transfusion in the Pre-ROTEM group was guided by measurements of standard laboratory coagulation tests in conjunction with the established major haemorrhage protocols at the time. The findings indicate that the ROTEM analyser was effective in managing MOH at point-of-care and led to a reduction in the transfusion of CRC, FFP and platelets. However, contrary to published studies, the reduction in blood product usage was not accompanied by an increase in fibrinogen replacement transfusion therapy, suggesting that the ROTEM’s FIBTEM assay accurately quantified fibrinogen levels based on fibrin-clot firmness to enable an early diagnosis of hypofibrinogenemia. Early establishment of the absence of hypofibrinogenemia helped to prevent unnecessary transfusion of fibrinogen concentrate in this study. These findings support the adoption of routine use of ROTEM analysers at point-of-care on labour wards to manage MOH and reduce fibrinogen replacement therapy. The ease of use and rapidity of ROTEM tests could enable departure from globally directed correction of coagulopathy during MOH to a more focussed and precise target transfusion therapy, which will ultimately reduce blood product wastage (including fibrinogen concentrate) whilst minimising transfusion-associated side effects such as alloimmunisation, circulatory overload and dilutional coagulopathy.

scholarly journals Tools to predict acute traumatic coagulopathy in the pre-hospital setting: a review of the literature

2020 ◽  
Vol 5 (3) ◽  
pp. 23-30
Author(s):  
Simon Robinson ◽  
Jordan Kirton
Keyword(s):  
Major Trauma ◽  
Point Of Care ◽  
Damage Control ◽  
Hospital Setting ◽  
Future Research ◽  
Blood Products ◽  
Point Of Care Testing ◽  
Acute Traumatic Coagulopathy ◽  
Prediction Tools ◽  
Traumatic Coagulopathy

<sec id="s1">Introduction: Recognising acute traumatic coagulopathy (ATC) poses a significant challenge to improving survival in emergency care. Paramedics are in a prime position to identify ATC in pre-hospital major trauma and initiate appropriate coagulopathy management. </sec> <sec id="s2">Method: A database literature review was conducted using Scopus, CINAHL and MEDLINE. </sec> <sec id="s3">Results: Two themes were identified from four studies: prediction tools, and point-of-care testing. Prediction tools identified key common ATC markers in the pre-hospital setting, including: systolic blood pressure, reduced Glasgow Coma Score and trauma to the chest, abdomen and pelvis. Point-of-care testing was found to have limited value. </sec> <sec id="s4">Conclusion: Future research needs to explore paramedics using prediction tools in identifying ATC, which could alert hospitals to prepare for blood products for damage control resuscitation. </sec>

scholarly journals Implementing a point of care testing (POCT) service improves management of haemostatic dysfunction in cardiac surgery patients

2014 ◽  
Vol 27 (1) ◽  
pp. 49
Author(s):  
B. Pearse ◽  
D. Wall ◽  
I. Smith ◽  
D. Faulke ◽  
I. Rapchuck ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Point Of Care ◽  
Point Of Care Testing
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